NASAP Student Leadership Institute Registration Form May 26-June 2, 2008 A separate registration form must be submitted for each participant. Please check one * Student Advisor Name * School Name * Address * City * State * - - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Phone Cell Gender * Female Male Fax Email Year in School Freshman Sophmore Junior Senior Student Organziation Anticipated Date of Graduation Fraternity/Sorority Affiliation, if any - - - - Choose One - - - - Alpha Kappa Alpha Sorority Inc. Alpha Phi Alpha Fraternity, Inc. Delta Sigma Theta Sorority, Inc. Iota Phi Theta Fraternity, Inc. Kappa Alpha Psi Fraternity, Inc. Omega Psi Phi Fraternity, Inc. Phi Beta Sigma Fraternity, Inc. Sigma Gamma Rho Sorority, Inc. Zeta Phi Beta Sorority, Inc. Other Other Affiliation Office(s) Held Office(s) Held Intake Date Career Goals Major T-Shirt Size * - - - - Choose One - - - - S M L XL XXL XXXL Early Registration through April 25, 2008 $550 Late Registration April 26-May 9, 2008 $600 Single Room: Add Additional cost $21x # of nights Yes No Vegetarian Meal Required Yes No